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The iliopsoas muscle group is comprised of the psoas major, psoas minor and iliacus. The psoas major muscle attaches to the vertebral bodies and discs of T12 and all of the lumbar vertebrae (L1-L5) and inserts on the lesser trochanter of the femur. The psoas minor is actually absent in 40% of people! When present, it attaches to the vertebrae and discs of T12 and L1 and in some cases to L2 as well. The psoas minor inserts on the pectineal line. The iliacus attaches to the superior 2/3 of the iliac fossa, the iliac crest, and the base of the sacrum and inserts on the tendon of the psoas major and the lesser trochanter of the femur. The action of this muscle group is hip flexion.

Why is it Important?

Dr. John Stump explains in his paper titled "America's Continued Back Attack", the increased amount of time Americans spend sitting each day and the lack of physical activity are at the root of the problem of back pain and obesity. While sitting, some of your muscles relax and some are overworked, remaining in this position for too long leads to muscle imbalance. The iliopsoas muscles become shortened and tight and can actually lose its functionality. When shortened, the muscle can pull on its attachment site in the low back, leading to low back pain.

Travell and Simons have mapped the trigger point pain referral of the psoas muscle and they have found that there are numerous locations in the psoas muscle where trigger points can refer to the low back. The most frequent complaints when a trigger point is present in the psoas muscle are low back and hip pain. The trigger points can be activated by prolonged sitting, driving and sleeping in a fetal position.

Treatment

To treat the psoas muscle I either have the patient lay in side posture or face up on the table. As the patient takes a deep breath in I will wrap my fingers around the iliac crest (the anterior superior iliac spine more specifically). Once in contact with the muscle, the patient is instructed to slowly straighten their ipsilateral (same side) leg. If tolerable, the patient can slowly internally and externally rotate their hip at that time and then bring hip and knee into flexion to relax the psoas muscle. Once in a relaxed position I once again ask the patient to take a deep breath and I sink my fingers deeper into the muscle and repeat. The location of this muscle deep within the abdominal cavity results in a very different feeling while receiving treatment. It is a very odd but yet relieving feeling.

Home Care

It is impossible to avoid sitting, as a society we work longer hours at our desk, we have longer commutes sitting our vehicles and we sit down at home after work more than ever before. Incorporating an exercise routine that focuses on strengthening the core and low back will have a long lasting beneficial effect. Additionally, there is a very simple practice that you can incorporate into your daily life that would help break this cycle of muscle shortening and low back pain.

The Bruegger's Relief Position is most effective when performed every 30-60 minutes. The position is achieved by sitting at the edge of the chair, with your legs slightly apart and your feet on the floor. The feet and knees should be slightly turned out and the pelvis tilted slightly forward. You should establish a slight “hollowing” of the lower back and increase its curvature (called lordosis).

Your chest should be lifted both up and out, which should allow the shoulders to settle backwards without strain. The arms are allowed to rest on the thighs with the hands facing forward. Lastly the chin is gently tucked in and the head high and facing directly forward. Open the pectoral muscles, allow for proper breathing, let the shoulders relax, and focus on gently drawing your shoulder blades down and together. Hold this position for approximately 10 seconds, relax and repeat two more times.